Having a Baby After Bariatric Surgery

OB JEN recently contributed to an article in Daily Rx regarding having a baby after Bariatric surgery.  You can read the full article below.

Pregnancy after bariatric surgery involved some risks but less so than obesity.  Pregnancy can involve more risks for women who are obese. As obesity rates rise, so does the number of women seeking bariatric surgery to treat their obesity.  A recent study considered what recommendations might be important for women who want to become pregnant after they have had bariatric surgery to treat obesity.

The authors concluded that women should wait at least a year, preferably 18 months, before becoming pregnant after the surgery. They may need additional nutrient supplements, and they should limit their pregnancy weight gain.  The authors also recommended that women discuss their options related to obesity, pregnancy and bariatric surgery with their doctors to make informed decisions.  “Ask your doctor about pregnancy after surgery.”  The study, led by Rahat Khan, MBBS, MRCOG, an OB/GYN at Princess Alexandra Hospital in Harlow in the United Kingdom, reviewed the current research related to pregnancy and bariatric surgery for obesity.

Obese women are more likely to have complications during pregnancy as well, so the researchers wanted to better understand possible pregnancy outcomes after a woman undergoes an increasingly used obesity treatment.  The National Institute for Health and Clinical Excellence in the UK recommends that morbidly obese women who have been unable to lose weight through lifestyle changes or medication could consider bariatric surgery.

The question is how long a woman should wait after she has bariatric surgery before she tries to get pregnant. The research on this question is sparse and sometimes contradictory.  Some studies found a higher risk of preterm (early) birth among women who got pregnant within a year of their surgeries.  Another study found a higher miscarriage rate (31 percent) among women who became pregnant within 18 months of their surgeries, compared to the miscarriage rate (18 percent) among women who waited at least 18 months after their surgery to become pregnant.

However, most studies did not find a higher risk of miscarriage, high blood pressure or gestational diabetes among pregnant women who had had bariatric surgery, regardless of how long they waited until after the surgery before becoming pregnant.  The research also found no differences so far in children’s birth weight, fetal growth restriction or cesarean section rates among women who conceived within a year of their surgery versus more than a year post-surgery.

Yet, since the evidence in this area is still thin and there are some studies to support the recommendation, the authors said that women should be advised to wait 12 to 18 months after their bariatric surgery before trying to become pregnant.

Jennifer Mushtaler, MD, an obstetrician in Austin, Texas and a dailyRx expert, said waiting after surgery to conceive also allows a woman to achieve a more consistent body weight.  “The greatest weight loss occurs in the first year after surgery, so many surgeons and obstetricians advise waiting at least one year after surgery before attempting pregnancy to allow weight to stabilize,” Dr. Mushtaler said.

The researchers also noted, however, that women tend to have improved fertility after bariatric surgery compared to morbidly obese women who do not undergo the surgery or otherwise lose weight.  The researchers noted that women who become pregnant after having bariatric surgery may experience nutritional deficiencies, especially with folate and vitamin B12. Therefore they should work with their doctors to ensure they are getting all the nutrients they and their developing babies need.  “Women will require additional levels of iron, calcium, folate, vitamin B12, protein and fat-soluble vitamins alongside diagnosis and treatment of other nutritional deficiencies,” the authors wrote.

In terms of weight gain during pregnancy, the authors said that the ideal amount for these women is between 15 and 24 pounds.  The authors also reviewed some of the complications that are possible among pregnant women who have had bariatric surgery. For those who receive gastric-banding, it is possible for the band to move or cause leaking in about 24 percent of cases. Only 4 percent of patients needed the band removed.

Overall, however, there were fewer complications among pregnant women who had bariatric surgery compared to morbidly obese pregnant women.  For example, one study found that 0 percent of pregnant women who had had bariatric surgery developed gestational diabetes, compared to 22 percent of obese pregnant women.  Similarly, the rate of pre-eclampsia in pregnant women who had had bariatric surgery was 0 percent, compared to 3.1 percent in obese pregnant women. Pre-eclampsia is a condition involving high blood pressure and protein in a woman’s urine. The only treatment is to deliver the baby.

Dr. Mushtaler said her experiences in treating women who became pregnant after having had bariatric surgery match up with what the researchers found in their review.

My experiences are consistent with the data in that fertility is improved and rates of complications are less,” Dr. Mushtaler said. “We do watch the infants for risks of growth restriction and we advise patients to take nutritional and vitamin supplements but limit caloric intake.”

In comparing women who had bariatric surgery to healthy weight women who have not had the surgery, there may be additional risks for miscarriage for two particular bariatric procedures: biliopancreatic diversion (BPD) and Roux-en-Y gastric bypass (RYGB).  One study found a miscarriage rate of 34.7 percent among women who had RYGB and 4 percent among women who had BPD. There was not evidence to show a higher miscarriage rate among women getting laparoscopic adjustable gastric banding (LAGB).

The authors concluded that women who have had bariatric surgery or are considering it should consult with their doctors, especially if they plan to have children.  “Both obstetricians and surgeons should consider post-bariatric surgery pregnant women as high risk,” the authors wrote. “Optimal education should be encouraged in these individuals so that they can make well-informed decisions about planning pregnancy after weight loss surgery.”

The study was published January 11 in the journal The Obstetrician and Gynaecologist. The research paper did not note any sources of funding. The authors declared no conflict of interest.

To schedule an appointment with any Capital Ob/Gyn physicians, call 512.836.2536 or visit www.capobgyn.com.  We look forward to seeing you soon at Capital Ob/Gyn!

Free Educational Event for Expecting Parents – Saturday, February 23rd

image001Join Capital Ob/Gyn this Saturday, February 23rd from 9:30 a.m. – 3:00 p.m. for a FREE educational seminar for expecting parents.  BabyEarth is bringing
together experts to provide you with informative sessions and interactive Q&As covering important birth and parenting topics.  Dr. Catherine Browne will be representing the Capital Ob/Gyn team on the Birthing Options Panel, so come see us and benefit from this unique event!

Getting Ready for Baby
Saturday, February 23rd

9:30 a.m. – 3:00 p.m.
Baby Earth – 106 E. Old Settlers Blvd. Round Rock, TX 78664
RSVP at www.babyearthbabyu.eventbrite.com

10:00AM-10:45AM- Infant Safety– We will review issues such as safe sleep, car seat safety, baby proofing, etc.

11:00AM- 11:30AM- Car Seat Installation– We will teach you how to properly install a car seat.

11:45- 12:30- Non-toxic Home and Baby– Toxic chemicals are poorly regulated and are found in everything from cleaning products to body lotion. You will learn how to be proactive in keeping your family and your home free of these harmful substances.

1:00-1:30- Creating a Birthing Plan– Having a plan relieves some of the stress of child birth. During this session you will learn the important things to consider when creating a birthing plan.

1:45-3:00- Birthing Options Panel– Join us with a team of experts to review your options for birth. A home water birth? A medicated birth in a hospital? Something in between? This birthing panel will talk about your options and answer your questions, so come prepared! The panel will include; Dr. Catherine Brown from Capital Ob/gyn; Chan McDermott child birth instructor; Leticia Moran a birth and postpartum Doula and we are awaiting confirmation on several others!

To schedule an appointment with any Capital Ob/Gyn physicians, call 512.836.2536 or visit www.capobgyn.com.  We look forward to seeing you soon at Capital Ob/Gyn!

Capital Ob/Gyn and VitaMed Partner to Impact Women in Nicaragua

As a team at Capital Ob/Gyn we are committed to empowering women and walking with them through all stages of life.  From local speaking engagements to overseas medical missions trips, each team member has found a unique way to contribute to women’s health beyond the walls of Capital Ob/Gyn.

Dr. Mushtaler focuses many of her efforts on educating women at her alma mater, The University of Texas at Austin.  On a recent occasion she had the privilege to speak to female members of the UT Triathlon team about women’s health, and through a relationship that began there she learned about the opportunity to sponsor the Global Medical Training mission trip to Nicaragua this January.

Capital Ob/Gyn in partnership with VitaMed has provided 750 prenatal vitamins that will be distributed through Global Medical Training to women in Nicaragua.01_ToCarol0006

Knowing they have a similar passion for the well being of women, Dr. Mushtaler called on Melissa Massey at VitaMed to join this effort.  Their quick and generous response will provide pregnant women in a severely under resourced area the chance for healthy development of their child.  VitaMed offers direct to patient supply of prenatal vitamins and iron supplements with vegan and gluten free options available at VitaMedrx.com. Their vitamins contain quatrafolate, the newest generation of folic acid supplement in prenatal vitamins.

Capital Ob/Gyn is glad to partner with Global Medical Training to raise awareness and impact healthcare locally and worldwide.  Global Medical Training is a student organization at The University of Texas at Austin that is committed to empowering students with the knowledge and awareness of the humanitarian need that exists in the world today by expanding students’ understanding of medicine and life outside the United States.  One of their primary objectives is to create awareness about the lack of access to healthcare, not only in third world countries but also in the local Austin community.  For more information on their efforts locally and internationally visit www.gmtut.com

To learn more about our practice visit www.capobgyn.com or call us at 512-836-2536 if you have any questions or to schedule your next appointment.

Annuals and New PAP Smear Guidelines

All of us have been touched in some capacity by cancer. Regarding cervical cancer, public education programs and PAP smear screenings have us on the victorious side of prevention. It is understandable that given years of education to women on the importance of annual cervical cancer screenings, there is confusion and concern over the newer guidelines.

First, let me say that the changes in cervical cancer screening recommendations are very well founded in significant advances in our technological capability. These recommendations are more than just a financial analysis of societal cost/benefit ratios (dig at conflicting breast cancer screening guidelines). Our newer technologies allow us to perform sensitive testing for Human Papilloma Virus (HPV) strains that are causative in the development of cervical cancer. If a woman has normal appearing cells, and she is free of high-risk strains of HPV, her risk of developing a cervical cancer is almost zero over the next few years. Second, let me emphasize that the PAP smear is only one aspect of care given at an annual exam and women should continue to have a yearly preventive check-up with their gynecologist. With that in mind, the newer PAP smear guidelines are as follows. 

Women age 21 and under are not recommended to have PAP smears. These women should have annual health check-ups to include screening for STD’s as indicated, initiation of the HPV vaccine, birth control counseling as indicated and complete health maintenance. If a woman under the age of 21 has not become sexually active, she does not need to have a pelvic exam, and time will be spent on other important aspects of a young woman’s health care.

Women age 21-29 should have an annual exam, well, every year! PAP smears should be obtained as part of that exam every 1-2 years. HPV testing is recommended for those women whose cellular analysis reveals atypical cells on the PAP. Annual health check-ups include blood pressure and weight screening, breast and pelvic exam, STD screening, contraceptive care and family planning.

Women age 30-65 should have an annual exam, you guessed it, every year! During these years many important health screenings will be conducted in addition to a pelvic exam. Women will have blood pressure, cholesterol, thyroid and diabetes screenings. Women will have regular breast exams and referrals for annual mammograms starting at age 40. Family planning, STD testing and contraceptive care is also included.  The PAP smear with HPV testing will be conducted every 3-5 years depending on the woman’s individual risk profile.

Women age 65 and older will follow current Medicare guidelines. In some women, PAP smears may be discontinued entirely, while others will have a PAP smear every 2 years. Women with HIV and/or a prior history of cervical cancer may be considered high risk and undergo annual PAP smear testing.

To summarize, all women should have an annual gynecological exam…every year! Many important aspects of woman’s health will be reviewed during that exam. Not sure what you should do? Starting last fall, women’s annual preventive exams are covered at 100% by commercial insurers, so give us a call at 512-836-2536 to schedule your exam. Our practice will have extra open exam slots for those patients needing to schedule before the end of the year. We are also offering a program for women who are without insurance to be able to get a preventive exam, PAP smear and gonorrhea/chlamydia testing.

Visit our website at www.capobgyn.com or call us at 512-836-2536 if you have any questions or to schedule your annual exam. You can also learn more from ACOG Practice Bulletin 131 “Screening for Cervical Cancer”.

Capital Ob/Gyn at the BiGHealthCARE Conference

At Capital Ob/Gyn we are always looking for ways to invest in the community, and we are honored to get involved with causes and efforts that empower and support women.  Recently, Dr. Browne was invited to be a speaker at a local healthcare conference called BiGHealthCARE put on by BiGAUSTIN (Business Investment Growth) held November 1st.  She will be leading a breakout session on the topic of breast and cervical cancer at the conference.

BiGAUSTIN is helping put Central Texas back to work with the first summit of a three part series of Small Business @ Work Summit: BiG HealthCARE.  A 7-hour small business summit for women and female veterans interested in starting or maintaining a small business in the healthcare industry.  The summit will consist of panel discussions and breakout sessions, exhibit booths for providers and small business owners, complimentary continental Breakfast and Lunch, and networking session. Topics covered include: Healthcare & Entrepreneurship; Small Business Assistance; Veteran Women Resources; Wisdom, Women & Wealth; How to provide Quality Senior Care and Care giving; Do you have what it takes?; Trends in Heart Disease, Obesity, Blood Pressure and Cholesterol; Business Etiquette and much more.

This event highlights the challenges and opportunities for women owned businesses, while emphasizing the vast emerging healthcare needs of all women and the unique needs of veteran women.  Click Here to find out more details about this event and how you can join.

As always, if you want to schedule an appointment with any of our physicians, call 512.836.2536 or visit www.capobgyn.com.  We look forward to seeing you soon at Capital Ob/Gyn!

New Class Offering: Birth, Baby and You

You asked and we said “Absolutely!”  Upon popular demand, Capital Ob/Gyn is excited to offer a new class called “Birth, Baby and You”.  Join us Saturday, November 10th from 9:00 a.m. to Noon at Capital Ob/Gyn Associates of Texas (12201 Renfert Way, Ste 325 Austin, TX).

This  class is tailored to your needs and will cover pregnancy, the experience of labor and delivery, postpartum care of mommy and newborn, as well as lactation basics.  The class will conclude with a guided tour of St. David’s Women’s Center. We are excited to welcome Lillie Juan, RN NP as the instructor of this class.  Ms. Juan is a registered RN and nurse practitioner with extensive experience in routine and high-risk pregnancy care.

Invite a friend to join you and call today (512.836.2536) to reserve your spot!  Class enrollment is $50 for the expectant mother and the support person of their choice and payment must be made in advance via check or cash to Capital Ob/Gyn.

You don’t have to be a patient of Capital Ob/Gyn to attend one of our classes, but we think that once you get a glimpse of our style you will want to be!  The next class offering will be in January and we will keep you updated on the details.

To schedule an appointment with any of our physicians, call 512.836.2536 or visit www.capobgyn.com.  We look forward to seeing you soon at Capital Ob/Gyn!

Summer News from Capital Ob/Gyn Associates

Thank you so much for your referrals, your praises and your online Yelp’s! Summer 2012 comes with several exciting updates. We are proud to announce our growing staff and team of physicians as well as our lovely expanded office space. Don’t worry though! We are keeping our comfortable and cozy feel.  Please join us for our open house in August and come see for yourself. In the meantime, read on to learn more about what’s new at Capital Ob/Gyn Associates!

Our Expanding Staff and Team of Physicians

Welcome Dr. Jane Braunstein and nurse Susan Paschall.  Dr. Jane Braunstein joined the practice in June 2012 and looks forward to meeting both new and existing patients.

Dr. Catherine Browne and her family are settling in nicely and loving the Austin community. Since joining the team in October 2011, Dr. Browne’s gentle demeanor and reassuring manner have been a great fit at Capital Ob/Gyn Associates.

Dr. Jennifer Mushtaler (OB JEN) is so happy with the growth and success of Capital Ob/Gyn Associates. She still finds time to stay active in the health and fitness arena. Capital Ob/Gyn Associates of Texas sponsored the Skeese Greets Triathlon and the Couples Triathlon. She and her husband Trent were spotted last weekend participating on the Couples Triathlon course as Team OB JEN. They make quite a team as weekend warriors!

Health and Lifestyle Fair at The University of Texas 7.20.12

Tomorrow, the Capital Ob/Gyn Associates of Texas Staff will be participating in a health and lifestyle fair at the University of Texas at Austin.  They look forward to meeting over 24,000 staff members and employees at UT and educating women of all ages about health and wellness.

Barta Boys Update

Capital Ob/Gyn Associates of Texas would also like to thank all those who lovingly supported and donated to the Barta Boys. We are pleased to report that the boys are making a miraculous recovery. We can’t wait to welcome Barbara back to the office later this month. Our professional and caring office staff creates a warm and welcoming atmosphere at the practice, ensuring your comfort each and every visit.

Our Expanded Office Space

If you haven’t been to the office in the last few months, you’ll see that we’ve moved a little down the hall! Our new space has allowed us to grow our team at our same convenient location, suite 325. We are located at Parmer and Mopac next to the St. David’s Austin Medical Center on Renfert Way.

Open House August 16th What better way to tour our new office space, meet our new staff members and chat with our physicians than an Open House! Guests are invited to join us at Capital Ob/Gyn Associates on Thursday, August 16th from 4-7pm. Hors d’oevres and beverages will be served. Visit our website for directions.

All of our physicians are accepting new patients and look forward to seeing you soon at Capital Ob/Gyn Associates of Texas! To schedule an appointment with any of our physicians, call 512-836-2536 or visit www.capobgyn.com.

Please support the Barta Boys and their family!

Capital Ob/Gyn Associates is deeply saddened by the Capital Metro fatality and tragedy that touched our family Monday morning. The children involved in the accident, Corbin 5 and Ethan 8, are the sons of our medical assistant, Barbara.  The two boys have sustained severe injuries and are receiving top-notch care.  Unfortunately, the boys lost their father, Jeremy Barta, while driving to school when their car was hit by the metro liner.

I had a lovely visit with Barbara and the boys this morning at the hospital. Barbara, always the giver, is pushing aside her own grief to tend to the physical and emotional needs of her boys. Ethan is beginning to eat and requested a hot dog for lunch. He took my hand to lead me to see Corbin in the ICU. Ethan is so brave and loving. Corbin is still heavily sedated, but his team is very encouraged by his progress. He will need multiple cranio-facial reconstructive surgeries and physical rehabilitation to be able to eat and talk. The road to physical and emotional recovery will be long, but this wonderful family is taking it one step at a time.

Click here to read the full details.

Barta Boys Support Fund
Please help us support the Barta Boys. Contributions will be placed in a fund to cover medical expenses and any leftover moneys will go into a trust for the boys. Thank you so much for giving to someone’s children who, herself, is usually the giver to others.

To donate click the button below.

Our thoughts and prayers are with our Barbara, Ethan and Corbin. We are so grateful for the excellent care they are receiving from our medical colleagues. We also wish to express our heartfelt condolences to Jeremy Barta’s family for their loss. All of them need our love and support.

With love, Dr. Jennifer Mushtaler, Dr. Catherine Browne, Dency Barrera, Lisa Golden, Lillie Herrera, Karen Ungar


Cap Ob/Gyn Springs into the Community in May!

Spring is here, and the doctors at Capital Ob/Gyn Associates of Texas are gearing up for some fun women’s health events next month.

Dr. Catherine Browne will be speaking at the Empowering Women Health Conference on May 5th, 2012. The conference strives to educate women and the community about the myriad women’s health issues and empower women to take care of themselves.  Dr. Browne will be talking about new guidelines in women’s medicine and answering questions like, “Do I really need a pap smear and mammogram every year?” Since the guidelines are always changing, Dr. Browne will tell attendees what’s changing and what you need to know to make informed decisions. This conference is already sold out, but will be one of many Women’s Health Conferences to come so stay tuned for more.

Capital Ob/Gyn Associates of Texas is very excited to be back in the Austin women’s triathlon community this season! Our friendly staff will be volunteering at the Skeese Greets Triathlon  packet pick-up on Saturday, May 12th at Jack & Adam’s Bicycles. Dr.Mushtaler (aka OB JEN) has previously sponsored the Skeese Greets Tri, Sweet & Twisted Tri, Cougar 5k, the Couples Triathlon and the Zooma Half Marathon-Austin. She’s also a triathlete herself, so don’t be afraid to ask questions about training or health while you’re there!

Make sure to keep an eye out for Capital Ob/Gyn around town and please visit our website or to learn more about our practice, OB JEN and Dr. Browne!

Daily Rx Recap: Complications for Mothers with Lupus

OBJen was recently quoted in Daily Rx regarding complications for mothers with lupus.  Read what she said below or click here to read the full article or go to www.dailyrx.com.

More Complications for Mothers with Lupus: Lupus May Reduce the Chance of Live Birth

Before getting pregnant, it is important to know if you are healthy enough to have a baby.  Certain diseases, such as lupus, can make pregnancy risky for both you and your child.

Women with lupus have less live births than otherwise healthy women.

Pregnancy is an exciting time for most women. However, it can be a stressful time as well, especially if the mother has lupus.

While it is entirely possible for a woman with lupus to have a healthy baby, she should also know the risks she faces before she decides to get pregnant.

Évelyne Vinet, M.D., of McGill University Health Centre in Montreal, and colleagues recently carried out a study to measure the number of live births in women with lupus.

The results show that women had 32 percent fewer live births after being diagnosed with lupus, compared to before diagnosis.

“Lupus is in the family of autoimmune disorders,” says Jennifer Mushtaler, M.D., an obstetrician in Austin, Texas. “As a whole, these disorders tend to complicate pregnancy for both mother and fetus.”

Dr. Mushtaler, who was not involved in the study, explains that these autoimmune conditions can lead to thrombophilias, or disorders that promote blood clotting, and other complications that can pose a risk to the placenta.

“As a generalist, I co-manage these pregnancies with a perinatologist,” she says. “We perform more aggressive surveillance on mother and baby during the pregnancy, and have a low threshold for early delivery if indicated on behalf of the baby or the mother.”

The study involved 1,334 women with lupus. These women had a total of 559 live births, which was lower than the expected number of 708 live births.

“After diagnosis, women with [lupus] have substantially fewer live births than the general population,” the authors conclude.

These findings suggest that doctors need to keep a close watch on their pregnant patients suffering from lupus.

The study is published in Annals of Rheumatic Diseases. 

To schedule an appointment with Dr. Mushtaler (OBJen) visit our website.